| NPI | 1114002136 |
|---|---|
| Doing Business As | WALT'S PHARMACY #2 |
| Entity Type | Organization |
| Authorized Contact | PATRICK J EGAN Third Party Coordinator 708-957-2974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: IL 054-11907) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2012-11-16 |